Sex differences in guideline-based statin utilization and recurrent events in patients with known coronary artery disease
Introduction: Current guidelines recommend using high-intensity statins in patients with atherosclerotic cardiovascular disease (ASCVD). Guideline directed statin intensity (GDSI) implementation and ASCVD outcomes may differ by sex. We evaluated sex-based differences in GDSI use and recurrent ASCVD...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-09-01
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| Series: | American Journal of Preventive Cardiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666667725001503 |
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| author | Agnes Koczo Jianhui Zhu Floyd Thoma Maha Mumtaz Steven Reis Oscar Marroquin Kathryn Berlacher Erin D. Michos Suresh Mulukutla Anum Saeed |
| author_facet | Agnes Koczo Jianhui Zhu Floyd Thoma Maha Mumtaz Steven Reis Oscar Marroquin Kathryn Berlacher Erin D. Michos Suresh Mulukutla Anum Saeed |
| author_sort | Agnes Koczo |
| collection | DOAJ |
| description | Introduction: Current guidelines recommend using high-intensity statins in patients with atherosclerotic cardiovascular disease (ASCVD). Guideline directed statin intensity (GDSI) implementation and ASCVD outcomes may differ by sex. We evaluated sex-based differences in GDSI use and recurrent ASCVD outcomes in a large healthcare network. Methods: Using electronic medical records, we assessed statin use and intensity in a cohort of patients with established coronary artery disease (coronary artery bypass grafting or percutaneous coronary intervention) between 2010-2022. Statins were categorized into GDSI (high intensity), <GDSI (moderate or low intensity) or no statin use. Outcomes of interest included recurrent myocardial infarction (MI), stroke/TIA and all-cause mortality. Incident rates (IR) and Cox regression hazard ratios (HR) of ASCVD outcomes were calculated across statin categories, stratified by sex. Results: We amassed data from 45,949 patients, of which 31 % were women. Women had more diabetes (29 % vs 24 %) and higher low density lipoprotein cholesterol [LDL-C] (94.9 ± 40.8 vs 87.6 ± 37.1 mg/dL) than men. During a follow-up period of ∼5 years, women were less likely to be started on GDSI (61.6 % vs 65.8 %, p<0.01) and achieve LDL-C<70mg/dL (41 % vs and 49 %, p<0.01) as compared to men. GDSI use lowered IRs for all outcomes in both sexes. As compared to men, women on GDSI had higher risk of MI (HR 1.21 [1.12-1.31)], stroke (1.21 [1.08-1.34] and mortality (1.12 [1.05-1.20]), all p<0.01). Conclusions: In a contemporary cohort of patients with coronary artery disease, women were less likely to be prescribed GDSI than men and less likely to achieve guideline concordant LDL-C<70mg/dL. This was associated with a higher risk of recurrent ASCVD events in women as compared to men. More sex specific interventions are needed to ensure adequate preventive treatment for both sexes. |
| format | Article |
| id | doaj-art-d28f2381a966450285f68bf2d5adcf14 |
| institution | Kabale University |
| issn | 2666-6677 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Preventive Cardiology |
| spelling | doaj-art-d28f2381a966450285f68bf2d5adcf142025-08-22T04:58:27ZengElsevierAmerican Journal of Preventive Cardiology2666-66772025-09-012310107510.1016/j.ajpc.2025.101075Sex differences in guideline-based statin utilization and recurrent events in patients with known coronary artery diseaseAgnes Koczo0Jianhui Zhu1Floyd Thoma2Maha Mumtaz3Steven Reis4Oscar Marroquin5Kathryn Berlacher6Erin D. Michos7Suresh Mulukutla8Anum Saeed9University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USAUniversity of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USAUniversity of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USAUniversity of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USAUniversity of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USAUniversity of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USAUniversity of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USAJohns Hopkins, Baltimore, Maryland, USAUniversity of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USAUniversity of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA; Corresponding author at: 200 Lothrop St, BST 17, VMI, Pittsburgh, PA 15213, USA.Introduction: Current guidelines recommend using high-intensity statins in patients with atherosclerotic cardiovascular disease (ASCVD). Guideline directed statin intensity (GDSI) implementation and ASCVD outcomes may differ by sex. We evaluated sex-based differences in GDSI use and recurrent ASCVD outcomes in a large healthcare network. Methods: Using electronic medical records, we assessed statin use and intensity in a cohort of patients with established coronary artery disease (coronary artery bypass grafting or percutaneous coronary intervention) between 2010-2022. Statins were categorized into GDSI (high intensity), <GDSI (moderate or low intensity) or no statin use. Outcomes of interest included recurrent myocardial infarction (MI), stroke/TIA and all-cause mortality. Incident rates (IR) and Cox regression hazard ratios (HR) of ASCVD outcomes were calculated across statin categories, stratified by sex. Results: We amassed data from 45,949 patients, of which 31 % were women. Women had more diabetes (29 % vs 24 %) and higher low density lipoprotein cholesterol [LDL-C] (94.9 ± 40.8 vs 87.6 ± 37.1 mg/dL) than men. During a follow-up period of ∼5 years, women were less likely to be started on GDSI (61.6 % vs 65.8 %, p<0.01) and achieve LDL-C<70mg/dL (41 % vs and 49 %, p<0.01) as compared to men. GDSI use lowered IRs for all outcomes in both sexes. As compared to men, women on GDSI had higher risk of MI (HR 1.21 [1.12-1.31)], stroke (1.21 [1.08-1.34] and mortality (1.12 [1.05-1.20]), all p<0.01). Conclusions: In a contemporary cohort of patients with coronary artery disease, women were less likely to be prescribed GDSI than men and less likely to achieve guideline concordant LDL-C<70mg/dL. This was associated with a higher risk of recurrent ASCVD events in women as compared to men. More sex specific interventions are needed to ensure adequate preventive treatment for both sexes.http://www.sciencedirect.com/science/article/pii/S2666667725001503ASCVDSex disparitiesWomen's cardiovascular healthCoronary artery diseaseStatins |
| spellingShingle | Agnes Koczo Jianhui Zhu Floyd Thoma Maha Mumtaz Steven Reis Oscar Marroquin Kathryn Berlacher Erin D. Michos Suresh Mulukutla Anum Saeed Sex differences in guideline-based statin utilization and recurrent events in patients with known coronary artery disease American Journal of Preventive Cardiology ASCVD Sex disparities Women's cardiovascular health Coronary artery disease Statins |
| title | Sex differences in guideline-based statin utilization and recurrent events in patients with known coronary artery disease |
| title_full | Sex differences in guideline-based statin utilization and recurrent events in patients with known coronary artery disease |
| title_fullStr | Sex differences in guideline-based statin utilization and recurrent events in patients with known coronary artery disease |
| title_full_unstemmed | Sex differences in guideline-based statin utilization and recurrent events in patients with known coronary artery disease |
| title_short | Sex differences in guideline-based statin utilization and recurrent events in patients with known coronary artery disease |
| title_sort | sex differences in guideline based statin utilization and recurrent events in patients with known coronary artery disease |
| topic | ASCVD Sex disparities Women's cardiovascular health Coronary artery disease Statins |
| url | http://www.sciencedirect.com/science/article/pii/S2666667725001503 |
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